Kwanghyun Lee

Aims To introduce a three-dimensional (3D) trajectory model that integrates structural and functional changes over time to improve assessment and prediction of glaucoma progression. Methods This retrospective longitudinal study included 1742 eyes from 996 glaucoma patients with ≥4 years of follow-up. Structural data from various devices were converted into a Structural Metascore (SMS), and the Visual Field Index (VFI) was used as the functional parameter. Robust linear regression was applied to each eye’s SMS and VFI over time. Eyes were categorised by baseline mean deviation (MD) into preperimetric (MD ≥0 dB), mild (−6 < MD < 0 dB), moderate (−12 ≤ MD ≤ −6 dB) or severe (MD <−12 dB). Progression was defined as a slope <−1% per year for SMS or VFI. Results Mean SMS slopes ranged from −0.1±0.8%/year (preperimetric) to −0.8±0.7%/year (severe) and VFI slopes ranged from −0.2±0.5%/year to −0.9±1.4%/year (pConclusion The 3D trajectory model visualises distinct progression patterns, with structural changes preceding functional decline in earlier stages and functional-only progression dominating in advanced stages. This integrated model enhances visualisation and quantification of disease dynamics, supporting personalised glaucoma management.

Background: The coronavirus disease (COVID‐19) pandemic significantly impacted medical care, including ophthalmology. This study aimed to identify factors associated with reduced ophthalmic medical access during the pandemic.Methods: This nationwide population‐based cohort study analysed South Korean health insurance claims data from January 2019 to November 2021. Outpatient visits and surgeries for age‐related macular degeneration, cataract, diabetic retinopathy, glaucoma, and retinal detachment during the two pandemic waves were compared with those in the non‐pandemic period. Poisson regression was used to estimate incidence rate ratios and changes in outpatient visits and surgeries between waves concerning patient age, sex, residential location, and health insurance type.Results: Outpatient visits for five eye diseases decreased in the first wave (0.733–0.985, P < 0.001). In the second wave, only outpatient visits for age‐related macular degeneration, cataract, and glaucoma decreased (0.754, 0.878, and 0.874, respectively, all P < 0.001). Age‐related macular degeneration, cataract, and glaucoma surgeries were significantly reduced in the first wave (0.829, P < 0.001; 0.836, P < 0.001; 0.904, P = 0.030, respectively). Age‐related macular degeneration (0.852) and cataract (0.716) surgeries dropped in the second wave. Women and elderly (>65 years) patients curtailed outpatient visits and surgeries more throughout the pandemic and were less resilient during the second wave. Wave location was also related to outpatient visits and surgeries.Conclusions: The COVID‐19 pandemic decreased outpatient visits and surgeries for eye diseases, with more significant impact on women, older patients, and those residing near wave locations. These findings can inform healthcare policies to minimise future pandemic impacts on healthcare delivery.

Précis: Glaucoma eyes with a small cup-to-disk ratio (CDR) tend to show retinal nerve fiber layer progression earlier than ganglion cell-inner plexiform layer progression. Purpose: To investigate the effects of clinical variables on the temporal relationship between macular ganglion cell-inner plexiform layer (mGCIPL) loss and peripapillary retinal nerve fiber layer (pRNFL) loss in glaucoma. Methods: This retrospective observational study used medical records of patients diagnosed with open angle glaucoma. Structural change was determined using guided progression analysis software of Cirrus optical coherence tomography. Based on the time of detection of pRNFL and mGCIPL changes, eyes showing progressive layer loss were categorized into the pRNFL-first and mGCIPL-first groups. The association between sites of layer thinning and clinical variables such as major retinal arterial angles and several optic disk measurements, including disk area, average CDR, and vertical CDR, were analyzed. Results: A total of 282 eyes were included in the study, of which 104 showed structural progression either in the mGCIPL or pRNFL. Out of these, 49 eyes showed the first progression in pRNFL, while 37 eyes showed the first progression in mGCIPL. The minimum mGCIPL thickness, pRNFL thickness, average CDR, vertical CDR, and location of progression were significantly different between the 2 groups (P=0.041, P=0.034, P=0.015, PPP=0.033 and P=0.006, respectively). The structural changes in the inferoinferior area and the superior vulnerability zone were significantly associated with RNFL-first progression (P<0.001 for both). Conclusion: The location of layer loss and CDR are related to the layer where loss is first detected (either pRNFL or mGCIPL) in open angle glaucoma.

Dry eye disease (DED) is characterized by impaired tear dynamics, leading to complex pathophysiological conditions. (PEG)-BHD1028, a peptide agonist to AdipoRs, was evaluated as a potential therapeutic agent for DED based on the reported physiological function of adiponectin, including anti-inflammation and epithelial protection. Therapeutic effects of (PEG)-BHD1028 were evaluated in experimentally induced EDE with 0.001%, 0.01%, and 0.1% (PEG)-BHD1028 in mice and 0.1%, 0.2%, and 0.4% in rabbits for 10 days. In the rabbit study, 0.05% cyclosporine was also tested as a comparator. The results from the mouse study revealed significant improvement in tear volumes, tear breakup time (TBUT), inflammation, and corneal severity score (CSS) within 10 days at all (PEG)-BHD1028 concentrations. In the rabbit study, the tear volume and TBUT significantly increased in (PEG)-BHD1028 groups compared with vehicle and 0.05% cyclosporine groups. The CSS, apoptosis rate, and corneal thickness of all (PEG)-BHD1028 and 0.05% cyclosporine groups were significantly improved relative to the vehicle group. The immune cell counts of 0.2% and 0.4% (PEG)-BHD1028 treated groups were significantly lower than those of the vehicle group. These results represent the potential of (PEG)-BHD1028 as an effective therapeutic agent for DED.

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Despite the clinical importance of glaucoma surgery, studies on its prevalence and risk factors are limited. We analyzed a database comprising approximately 1,000,000 Korean residents to investigate the prevalence and risk factors for undergoing glaucoma surgery within 5 years of diagnosis with open-angle glaucoma. Of the 4,303 patients evaluated, 226 (5.3%) underwent glaucoma surgery. Factors associated with the likelihood of glaucoma surgery included the use of two or more eye drops (odds ratio [OR], 30.30; 95% confidence interval [CI], 10.95–83.84), intake of oral carbonic anhydrase inhibitor (OR, 1.79; 95% CI, 1.23–2.61), age > 55 years (55–65 years: OR, 1.71; 95% CI, 1.06–2.76; > 65 years: OR 1.72; 95% CI, 1.10–2.70), female sex (OR, 1.46; 95% CI, 1.10–1.94), middle- and high-income (OR, 2.36; 95% CI, 1.30–4.28, OR, 1.86; 95% CI, 1.03–3.35, respectively), and metropolitan residence (OR, 1.61; 95% CI, 1.14–2.26). Our nomogram for predicting the likelihood of glaucoma surgery showed an acceptable result. In conclusion, older age, female sex, and the intensity of intraocular pressure lowering treatment increased the likelihood of undergoing glaucoma surgery. Our findings indicated that a lower socioeconomic status may forestall receiving this necessary surgery, which requires further attention.

Précis: Different clinical factors are associated with the location of the first structural progression in glaucoma. Purpose: The aim was to investigate the underlying clinical parameters affecting the location of the initial structural progression of glaucoma in patients with normal-tension glaucoma (NTG). Methods: This retrospective study included 228 eyes of 228 patients with NTG. In total, 130 eyes of 130 patients demonstrated structural progression (as determined by event-based guided progression analysis using Cirrus HD-optical coherence tomography) in the peripapillary retinal nerve fiber layer (ppRNFL) or macular ganglion cell inner plexiform layer (mGCIPL). Depending on where the progression occurred first, it was defined as either ppRNFL first progression or mGCIPL first progression. Clinical parameters associated with each first progression were identified using logistic regression. Results: In total, 50 eyes showed ppRNFL first progression and 64 eyes showed mGCIPL first progression. ppRNFL first progression was significantly associated with female sex [odds ratio (OR)=5.705, P=0.015], lack of systemic hypertension (OR=0.199, P=0.014), disc hemorrhage (OR=4.188, P=0.029), higher mean intraocular pressure (OR=1.300, P=0.03), and lower pattern SD (OR=0.784, P=0.028). In contrast, male sex (OR=0.450, P=0.043), lower central corneal thickness (OR=0.987, P=0.032), higher intraocular pressure fluctuation (OR=1.753, P=0.047), lower systolic blood pressure fluctuation (OR=0.839, P=0.002), and higher diastolic blood pressure fluctuation (OR=1.208, P=0.015) were significantly associated with mGCIPL first progression. Conclusions: Different clinical factors were associated with the initial site of structural glaucoma progression in patients with NTG depending on its peripapillary or macular location, and these findings suggest possible differences in underlying mechanisms of glaucoma damage.

As laser refractive surgeries (LRS) have been widely performed to correct myopia, ophthalmologists easily encounter patients with glaucoma who have a history of LRS. It is well known that intraocular pressure (IOP) in eyes with glaucoma is not accurate when measured using Goldmann applanation tonometry. However, risk factors for glaucoma progression, particularly those associated with measured IOP, have rarely been studied. We analysed data for 40 patients with a history of LRS and 50 age-matched patients without a history of LRS. Structural progression was defined as significant changes in thickness in the peripapillary retinal nerve fibre layer as identified using optical coherence tomography event-based guided progression analysis. Risk factors were determined via Cox regression analysis. Disc haemorrhage (DH) was associated with glaucoma progression in both the non-LRS group and LRS group (hazard ratio (HR): 4.650, p = 0.012 and HR: 8.666, p = 0.019, respectively). However, IOP fluctuation was associated with glaucoma progression only in the LRS group (HR: 1.452, p = 0.023). Our results show that DH was a significant sign of progression in myopic glaucoma eyes. When treating patients with myopia and glaucoma, IOP fluctuation should be monitored more carefully, even if IOP seems to be well controlled.